Femoral Shaft Fractures In Children Research Articles

Pelvic pressure changes after a fracture: A pilot cadaveric study assessing the effect of pelvic binders and limb bandaging

Pelvic pressure changes after a fracture: A pilot cadaveric study assessing the effect of pelvic binders and limb bandaging

Fixator-augmented flexible intramedullary nailing for osteopenic femoral shaft fractures in children.

Children with underlying metabolic bone diseases, such as osteogenesis imperfecta and spastic cerebral palsy, pose a challenge in the treatment of femoral shaft fractures. We performed flexible intramedullary nailing with supplemental monolateral external fixation in a subgroup of such patients. The external fixator assists in controlling angulation and rotation at the fracture site, and avoids the need for supplemental casting with its associated problems such as skin breakdown and difficulty with personal hygiene. We describe the surgical technique, pitfalls, and outcomes in a series of four patients with underlying osteopenia treated with external fixator-augmented flexible nailing for femoral shaft fractures.

The Results of Retrograd Intramedullary Elastic Nailing in the Treatment of Pediatric Femoral Shaft Fractures

The aim of this study was to evaluate the results of retrograd intramedullary nailing treatment in children with femoral shaft fracture. METHODS: In this study, 20 patients, were included who applied to Mustafa Kemal University Research Hospital and were treated with retrograd intramedullary elastic nailing because of femoral shaft fracture. RESULTS: The mean age of our patients was 14.5 months (9–24 months) and mean follow-up time was 8.3 years (4.5–14 years). The average length of stay in hospital were 3.4 days. The average reunion duration were detected as 7.8 weeks. There was no significant difference between reunion durations of open and closed fractures. Valgus alignment of 7 degrees was observed in one patient and 5 degrees in one other patient. But it did not result any functional or clinical restrictions. There were not any increase of anterior-posterior angle or any rotational deformities observed. Extremity length difference below 1cm was detected in 3 of the patients and length difference between 1–1.5 cm was detected in 2 patients. When patients were evaluated according to Flynn’s criteria, the results were excellent in 14 patients (70%), good in 5 patients (25%) and poor in 1 patient (5%). CONCLUSION: Elastic intramedullary nailing treatment of femoral shaft fractures in children between 5–14 years of age is a safe and effective treatment.

Controversies in orthopaedic trauma--management of fractures of shaft of femur in children between 6 and 12 years of age.

The management of femoral shaft fractures in children is largely directed by the age and built of the child. There is wide consensus on the non operative treatment of children less than six years of age. Operative treatment is recommended for children more than 12 years of age, only the surgical options vary. The age group of 6-12 years remains a controversial area with multiple studies advocating different lines of treatment. We studied the literature on treatment of femoral shaft fractures in 6 to 12 year age group over the past 25 years through PubMed search and found 79 studies dealing with management of paediatric shaft femur fractures in this age group. Studies dealing with other age groups, animal studies and languages other than English were excluded. The treatment modalities included early or immediate hip spica, traction alone, external fixator, plating (open/minimally invasive), intramedullary nailing- rigid/flexible and intramedullary Kirschner wire. The short listed articles were studied for rate and time of union, complications such as non-union and malunion, leg length discrepancy, infection, implant impingement, refracture and cost analysis. Operative treatment is usually the preferred treatment option in this age group, as it decreases hospitalization time, decreases morbidity and allows early return of child to school. Flexible intramedullary nailing is recommended for length stable fractures. Submuscular bridge plating (minimally invasive) is reserved for comminuted fractures. External fixator is reserved for open fractures and initial stabilization of femoral shaft fractures in polytrauma pediatric patients. Intramedullary K wire is a viable option in resource contrained centres where specialized implants and instrumentation is not available.

Femoral shaft fractures in young children (

Femoral shaft fractures comprise around 4% of all long-bone fractures in childhood. There is controversy about the treatment of fractures in children below 5years, between those preferring non-operative methods, such as casting or traction, and those supporting elastic stable intramedullary nailing (ESIN). This retrospective study evaluates the day-by-day treatment of femoral shaft fractures in children aged 6-60months in four major paediatric surgery trauma centres in Germany from 1 January 2004 to 31 December 2011 by chart review. We analysed all patient-related data, causes of fracture, fracture type, treatment method and potential post-treatment complications. We identified 225 patients (male to female 2:1) with femoral shaft fractures. Around 2/3 of these resulted from falls of less than 1m or 1-3m, the most frequent result (>40%) being a long spiral fracture. All 19 children below 1year of age were treated by casting or traction. Between the ages of 12 and 24months (n=56), different treatment concepts were preferred (1/5 ESIN, 2/5 traction and 2/5 spica casting). Between 24 and 36months, operative and non-operative therapies were equally distributed. In children older than 36months (n=64), most fractures were treated by ESIN: six children by external fixation and 14 by other treatments like spica casting, plate osteosynthesis or a combination of methods. 42 changes of treatment were performed: traction to spica casting or secondary operative treatment and 21 complications occurred (nails left in place for too long, skin defects or wound infections). Spica casting of femoral shaft fractures or, in some cases, traction is still the preferred treatment in the first and second years of life. In the third year, children are treated operatively as well as non-operatively, although now there is no current evidence of better short-term outcomes in operatively treated children. But elastic stable intramedullary nailing is the standard treatment for femoral shaft fractures in children older than 3years of age.

Interventions for Treating Femoral Shaft Fractures in Children and Adolescents

Interventions for Treating Femoral Shaft Fractures in Children and Adolescents

The Effect of a Femoral Fracture Sustained before Skeletal Maturity on Bone Mineral Density: A Long-Term Follow-Up Study

Background and Purpose. The possible effect of pediatric femoral fractures on the bone mineral density (BMD) is largely unknown. We conducted a study to investigate BMD in adults who had sustained a femoral shaft fracture in childhood treated with skeletal traction. Materials and Methods. Forty-four adults, who had had a femoral fracture before skeletal maturity, were reexamined on average 21 (range 11.4) years after treatment. Our follow-up study included a questionnaire, a clinical examination, length and angle measurements of the lower extremities from follow-up radiographs, and a DEXA examination with regional BMD values obtained for both legs separately. Results. At follow-up femoral varus-valgus (P=0.001) and ante-/recurvatum (P=0.001) angles were slightly larger in the injured lower-limb compared to the contralateral limb. The mean BMD of the entire injured lower-limb was lower than that of the noninjured (1.323 g/cm2 versus 1.346 g/cm2, P=0.003). Duration of traction was the only factor in multiple linear regression analysis that was positively correlated with the BMD discrepancy between the injured and noninjured lower-limb explaining about 17% of its variation. Conclusion. The effect of a femoral fracture sustained during growth is small even in patients treated with traction.

Femoral shaft fractures in children under 3 years old. Current treatment standard

Femoral shaft fractures in children are a common injury. Operative treatment is recommended for children above 3years of age. The question of this investigation was the current clinical standard for the treatment of femoral shaft fractures in children under 3years old. An e-mail questionnaire was sent to all clinics and hospital departments of the members of the German Society for Trauma Surgery and the German Society of Pediatric Surgery. Out of 775 clinics and departments, 121 participated in the survey (16 %). From 2011 to 2012 overall 756 femoral shaft fractures of children 3 years and younger were treated of which 375 (50 %) were stabilized with elastic stable intramedullary nailing (ESIN), 183 (24 %) with an overhead extension, 178 (23 %) with a plaster cast and 9 (1 %) with external fixation. Finally, operative treatment was used in 51 % compared to 49 % with conservative treatment. Obviously, operative treatment of femoral shaft fractures in children younger than 3years is routinely used despite the fact that there is no evidential basis for this approach. There are good arguments for and against operative and conservative forms of treatment. Indications for operative treatment include multiple trauma, open fractures, body weight over 20kg, child already free walking and lack of stable fixation with conservative treatment. To achieve more evidence for the existing recommendation of the American Academy of Orthopaedic Surgeons (AAOS) and the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF, Working Group of the Scientific Medical Specialist Societies), further investigations are needed.

Interventions for treating femoral shaft fractures in children and adolescents.

Interventions for treating femoral shaft fractures in children and adolescents.

Children’s Orthopaedics

The October 2014 Children’s orthopaedics Roundup360 looks at: spondylolisthesis management strategies; not all cervical collars are even; quality of life with Legg-Calve-Perthe’s disease; femoral shaft fractures in children; percutaneous trigger thumb release – avoid at all costs in children; predicting repeat surgical intervention in acute osteomyelitis; and C-Arm position inconsequential in radiation exposure

Interventions for treating femoral shaft fractures in children and adolescents.

Interventions for treating femoral shaft fractures in children and adolescents.

Results of the treatment of the open femoral shaft fractures in children

BackgroundIntramedullary nailing has become the treatment of choice for closed femoral shaft fractures in children and adolescents. Immediate intramedullary nailing of open fractures of femur in children remains controversial, with most surgeons preferring to treat grade II or III open fractures either by debridement and traction or external fixation. The aimsThe aim of this study is to evaluate the results of intramedullary nailing of open femoral fractures in children. Methods172 children were treated for femoral shaft fracture in our department. 19 fractures were opened in 18 patients. ResultsIn children with polytrauma, multiple fractures, head injuries and other conditions which necessitate intensive nursing care, intramedullary nailing of opens femoral shaft fractures (type I, II, IIIA, IIIB) should be preferred. ConclusionSatisfactory results were obtained in all patients in terms of self evaluation of patients, radiological and clinical evaluation. The infection rate was much lower for patients who had been given a cephalosporin than for patient who had been given a penicillin or had been given no antibiotic.

Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup

Background:In children less than 6 years, the treatment of femoral shaft fracture is often non surgical, using closed reduction and casting. The literature reports many experience about this type of trauma but none of these has a long term followup. We present a retrospective study on a group of femoral diaphyseal fractures treated nonsurgically in children up to 6 years of age, with a minimum of 10 year followup.Materials and Methods:48 cases (36 males/12 females) with femoral diaphyseal fractures treated between January 1988 and December 1998 were reviewed. Patients with fractures due to obstetrical trauma and pathologic fractures were excluded. The mean age of the patients was 3.3 ± 1.1 years (range 5 months-6 years). Right side was involved in 21 cases (44%), and left side in 27 cases (56%). In 34 cases (71%), closed reduction was performed and hip spica was applied with the hip and knee flexed to 45°. In 8 cases (17%), skeletal traction was applied to perform fracture reduction and the traction pin was embedded in plaster while in the remaining 6 cases (12%), the Delitala pressure apparatus was applied after casting.Results:All fractures healed in our study. There were no complications (infection or vascular nervous issues, axial deviations, consolidation delays, or pseudoarthrosis). In 13 cases (27%), followup examinations showed mean lengthening of 1.3 ± 0.75 (range 0.5-2.5 cm) of the fractured lower limb. All these patients were treated with skin traction before treatment and presented with 2.08 ± 0.28 cm mean initial femoral shortening. In 1 case (2%) with 2.5 cm lengthening, epiphysiodesis of the ipsilateral knee was performed. No patients showed prolonged difficulty with gait disorders.Conclusion:On the basis of our results conservative treatment of femoral shaft fractures in children can be considered less invasive and safe procedure.

Elastic stable intramedullary nailing of femoral shaft fractures in children: Particularities and results at Sylvanus Olympio teaching hospital of Lomé, Togo

The elastic stable intramedullary nailing (ESIN) presently seems the best technique in the surgical treatment of femoral shaft fractures (FSF) in >6-year-old children. We hereby report technical difficulties and therapeutic results after our first 8 years of experience. It's a retrospective study over a period of 8 years from January 2005 to December 2012 in the Paediatric Surgery Department of Sylvanus Olympio Teaching Hospital of Lomé. Indications, technical particularities and results were studied. There were 32 patients, 17 were boys and 15 were girls, with a mean age of 11 years old. The mean time to surgery was 21 days (range: 14 and 51 days). A callus was always removed before reduction. The osteosynthesis was stable in 22 cases, but in 10 others, it had been completed with a cast immobilisation. The operation needed a blood transfusion in 18 cases. With a mean follow-up of 3.5 years, the results were excellent in 29 patients (90.63%) and good in 3 patients (9.37%). Although undertaking an ESIN can be difficult, due to the lack of adequate equipment the procedure produces satisfactory outcome.

5 歳以下の大腿骨骨幹部骨折に対し逆行性弾性髄内固定を施行した3 症例

5 歳以下の大腿骨骨幹部骨折に対し逆行性弾性髄内固定を施行した3 症例

Comparison Between Closed (Immediate Spica, Traction/Spica Cast) and Open Fixation (Plate Fixation) in Femoral Shaft Fractures in Children Below Nine Years Old Who Had Recoursed to Mashhad Imam Reza Hospital From 2002 to 2007

lower third (distal) femoral shaft fractures. Thirteen fractures (50%) were treated with immediate Spica cast, six fractures (23%) received traction and Spica cast, and surgical fixation with plate was carried out in the remaining seven cases. Results: After a follow-up interval of at least 5 years, angle deformity was the most common complication observed in 32% of the studied patients. Limb length discrepancy and rotational deformity were observed in 24% and 16% of the cases. Treated with immediate Spica cast proved to have the highest complication prevalence of all (92.2%) and was followed by traction and Spica cast (83.4%) and were observed in patients' surgical fixation with plate (14.3%). Conclusion: According to the results, internal fixation with plates can be considered an appropriate technique in cases of pediatric femoral shaft fractures.

Comparison Between Closed (Immediate Spica, Traction/Spica Cast) and Open Fixation (Plate Fixation) in Femoral Shaft Fractures in Children Below Nine Years Old Who Had Recoursed to Mashhad Imam Reza Hospital From 2002 to 2007

Comparison Between Closed (Immediate Spica, Traction/Spica Cast) and Open Fixation (Plate Fixation) in Femoral Shaft Fractures in Children Below Nine Years Old Who Had Recoursed to Mashhad Imam Reza Hospital From 2002 to 2007

Algorithm for the management of femoral shaft fractures in children

Pediatric closed femoral shaft fractures are commonly related to a good prognosis. There is no consensus on treatment. We aimed to evaluate the treatment, features, radiological findings and management strategies, creating an algorithm of treatment. Fifty-two simple femoral shaft fractures in children were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, limb length discrepancy, range of knee and hip motion and parents satisfaction with a mean clinical and radiographic follow-up of 3 years and 6 months. Twenty-eight patients were treated with reduction and early hip spica cast while 24 patients were treated with external fixation (EF). Nearly 58 % of the cases were caused by traffic accidents and were predominantly male (61.5 %). Most of the fractures were of the middle femoral shaft (57.6 %). Muscle strength was normal (MRC scale) in all patients with no pain (NIPS and PRS scale). Knee and Hip range of motion were similar in both types of treatment. Patients treated with EF had shorter limb length discrepancy compared with SC. There were no reports of re-fracture. We found a higher familiar satisfaction in patients treated with EF. An algorithm for the management of femoral shaft fractures in the pediatric population is proposed. Results on the study population gave raise to a satisfactory clinical and radiological results.

Intramedullary splinting of femoral shaft fractures in children with flexible nails: early results

Indications for flexible intramedullary nailing, as well as advancements in this technique, have evolved considerably with time and individual experience. We implemented and studied a simplified version of the technique. Functional outcome, osseous union and related issues are discussed. A total of 15 patients aged 5-15 years with diaphyseal femur fracture were selected for the study. The patients' fractures were stabilised with flexible intramedullary nails through lateral entry alone. After a minimum follow-up period of six months, the outcomes were analysed. The mean patient age was 8.7 years, and patients were followed up for a mean duration of 12 months. Radiological union was achieved within a mean duration of 7.5 weeks. The outcomes were excellent in most of the cases. Adequate fixation was achieved through the use of flexible nails as intramedullary splints. The results were comparable to that of the original technique. Further study is obligatory.

Complications of plate fixation of femoral shaft fractures in children and adolescents

This study aims to critically analyze the major and minor complications that may be associated with plate fixation of pediatric diaphyseal femur fractures. The medical records of skeletally immature patients (6-15years of age) who underwent plate fixation of a diaphyseal femur fracture at a tertiary-care level-1 pediatric trauma center between 1/2003 and 12/2010 were reviewed. Demographic and clinical information regarding the mechanism of injury, fracture type, and surgical technique were recorded. Radiographic evaluation of bony healing, hardware position, and deformity was performed throughout the study period. All intraoperative and postoperative complications were recorded. Complication incidence and time from surgery to complication were described. Multivariate logistic regression and multivariate Cox regression models were used to assess the association between different variables and the occurrence of a complication. Kaplan-Meier survivorship curves were used to evaluate the freedom from a complication with longer follow-up. Over an 8-year period, 85 skeletally immature patients (83% males, mean age 10.2 years) underwent plate fixation for diaphyseal femur fractures. Overall, complications were identified in 11 patients (13%). Major complications, defined as those resulting in unplanned reoperation (excluding elective removal of asymptomatic plate/screws), occurred in five patients (6%) and included two patients (2%) with wound infections requiring irrigation and debridement, two patients (2%) with distal femoral valgus deformity (DFVD) leading to osteotomy and hardware removal, respectively, and one patient (1%) with a 3-cm leg length discrepancy (LLD) requiring epiphysiodesis. Minor complications, defined as those not requiring unplanned operative intervention, occurred in six patients (7%) and included two patients (2%) with delayed union, two patients (2%) with symptomatic screw prominence, one patient (1%) with a superficial wound infection effectively treated with oral antibiotics, and one patient (1%) with valgus malunion, which was asymptomatic at early follow-up. There were no intraoperative complications and no reports of postoperative knee stiffness, shortening, or reoperations to address fracture stability. Fifty-two patients (61%) underwent routineelective removal of hardware without related complications following fracture union. Overall, complications occurred postoperatively at a mean time of 20months (range 0-65months), though major complications occurred at a later time point (mean 29.1months, range 0-65months) than minor complications (mean 12.5months, range 0-40.1months). Longer follow-up was associated with higher occurrence of a complication [p=0.0012, odds ratio=1.05, 95% confidence interval (CI): 1.02-1.08]. The plating of pediatric femur fractures is associated with 6 and 7% rates of major and minor complications, respectively. There were minimal long-term sequelae associated with the complications noted. This complication rate compares favorably with the published rate of complications (10-62%) associated with titanium elastic nail fixation of similar fracture types. Most complications occurred >4months postoperatively, with major complications occurring at a later time point than minor complications. Long-term follow-up of these patients is recommended to ensure that complications do not go undetected. Retrospective case series, Level IV.